The 42 diseases in Fujian Province began to be paid for by disease

November 16th, Fujian Provincial Health Insurance Bureau, the Joint Health And Health Commission, issued a notice - on the fifth batch of provincial public hospitals by disease collection and payment related issues (hereinafter referred to as Notice) will once again pay by disease to the deep water area: wheezing, fractures, cough disease, kidney failure, heart failure, low back pain, stroke, disease and other 42 kinds of diseases will be implemented in Fujian Province pay-per-view reform. According to official data, these disease charges in the range of about 5000 to 10000 yuan, they will be in the province's public hospitals and the 900th hospital, where the main diagnosis, the main operation in line with the regulations of the management of pay-per-disease basic medical insurance insured patients and out-of-charge patients should be included in the scope of pay-per-disease.

chinese medicine to encourage the increase of the proportion of Chinese medicine treatmentIt is understood that Fujian Province in order to encourage and support the development of the cause of Traditional Chinese medicine, highlighting the characteristics of Chinese medicine advantages, play the role of pay-per-disease reform in promoting the coordinated development of Chinese and Western medicine, and constantly improve the chinese medicine service charging policy, the selection of 42 treatment programs mature, controllable quality, stable cost of common advantages of Chinese medicine diseases to implement pay-per-disease reform, as the fifth batch of provincial public hospitals to collect paid diseases.It is worth noting that the current batch of medical insurance payment policy in accordance with the former Fujian Provincial Health Insurance Office and the Provincial Health Planning Commission "on the provincial public hospitals by disease charges and payment related issues notice" and other documents, that is, the insured personnel in the designated medical institutions included in the disease fee management of the disease costs, medical insurance in accordance with the disease charge standard settlement, no starting line, by individuals and co-ordination funds to share the proportion of the provincial health insurance payment policy.To this end, the Notice requires all units to strengthen the management of pay-per-disease, carry out quality control of Chinese medicine-based disease services, implement detailed clinical pathways, strengthen the management of disease collection and payment audit, and further standardize the behavior of diagnosis and treatment. Provincial public hospitals should give full play to the role of informationization, integrate the clinical path of Chinese medicine diseases into information management, improve the collection of information on the home page of Chinese medicine disease cases, and improve the level of information management of Chinese medicine diseases. At the same time, it is required that the provincial public hospitals should focus on Chinese medicine treatment, pay attention to the role of Chinese medicine advantages, increase the proportion of Chinese medicine treatment in Chinese medicine diseases year by year, optimize the income structure of Chinese medicine diseases, and continuously improve the overall proportion of Chinese medicine medical services. Literally, these diseases will be more inclined to the use of Chinese medicine.

to achieve "patient-side" fee-for-It is understood that recently four places in Fujian (Xiamen, Ningde, Yantian, Longyan) were selected as the total regional points method budget and pay according to the disease score pilot city. In fact, as the star province of the reform of health insurance payment methods, 22 county-level and above public hospitals in Sanming City have been fully integrated into the C-DRG collection and payment management since January 1, 2018.In practice, the number of C-DRG disease groups in Sanming City reached 796 groups, covering 67% of discharged patients. As the first "patient-side" collection reform, C-DRG is priced and paid in groups. In Yuxi County, Sanming City, Yuxi County insured patients in Yuxi County General Hospital, Yuxi County Chinese Medicine Hospital for medical treatment, except for special circumstances, hospitalization costs cancel the starting line, the medical insurance fund according to the fixed reimbursement of 70% of the disease, 30% of the patient's own payment.Overall, the pay-per-disease reform sets a "double standard" for hospital fees and health insurance payments to patients, a practice that makes patients aware of the burden of medical care. At the same time, the most important, can also stimulate the hospital to control the cost of endo-driven. So many parts of the country are also learning from Sanming's approach.At present, the number of diseases paid for by disease in Fujian Province has reached more than 700. In 2019, Xiamen City, on the basis of zero basic budget for medical insurance, fully implemented the "point method under the total budget" payment system reform. The increase in the total cost of health insurance in the city fell to 13% from an average of 15.93% in the year before the reform, and the year-on-year increase in hospitalization expenses decreased by nearly 10 percentage points.Of course, such reforms are only a way to go. Due to the lack of standardized and standardized governance of data in china at this stage, there are great differences between existing medical data and medical practice, there are some innate deficiencies, from this point of view, based on the big data of the disease score payment, there are also large fluctuations, deviation from the clinical reality of the possibility and risk, but also need to pilot verification process. (Medical Economics)